International Membership Application

Membership Application (International)

Join us. Start the application process online today. If you know your ADA number, you may enter it and press the search button to update your profile. Otherwise, please complete the form and submit your online application.

You can also download and mail in a PDF application.

Have questions? We'd love to help:

call us at 800.621.8099
email International-Member@ada.org

* indicates required field.

Personal Information

ADA Number

Last Name

*Required

First Name

*Required

Date of Birth

Month:

Day:

Year:

Gender

MaleFemale

Education Information

Please attach a copy of your dental school diploma (English translation required). If you cannot attach a copy, fax a copy to the American Dental Association at 312-440-3542 or mail it to: American Dental Assn, Attn: International Membership, 211 E Chicago Ave, Chicago, IL 60611 United States.

Country of Residence

*Required

Country of School Attended

*Required

Dental School

*Required

Graduation Date

*Required Month:

Year:

*Required Degree:

Attach File Only Word/PDF file less than 1MB size is allowed

Postal Address Information

Home Postal Address

Street Postal Address

*Required

Country

*Required

State/Province

*Required

City

*Required

Postal Code

*Required

Phone Number
(Country Code - Area Code - Phone Number - Extension)

*Required

Fax Number

Primary Email Address

*Required If you provide an email address, the ADA will communicate with you at this address.

Secondary Email Address

If you provide an email address, the ADA will communicate with you at this address.

Business Postal Address

Street Postal Address

*Required

Country

*Required

State/Province

*Required

City

*Required

Postal Code

*Required

Phone Number
(Country Code - Area Code - Phone Number - Extension)

*Required

Fax Number

Preferred Postal Address

*Required

Dues Information

You are currently requesting International (Non-U.S.) Membership in the ADA .

I would like to receive a hard copy of JADA via mail (4-6 weeks delivery time) for an additional cost of $102.

Airmail delivery of JADA (2-3 weeks delivery time), at an additional cost of $100. Please be sure to select JADA subscription if you select Airmail.

I hereby apply for International membership in the American Dental Association and resolve to abide by the Bylaws and Code of Ethics and Professional Conduct if accepted into membership.

*Required

Member personal information may be shared as described in the Privacy Notice and Terms of Use, for example ADA shares certain information about members with third parties, such as ADA state and local dental societies.

Membership Application (International)

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